As the challenge grows for the European community to support cancer patients and survivors in conciliating the disease or its consequences with a professional activity, more studies are still needed to grasp the global impacts of cancer on work as well as the impact of employment on people with cancer. To provide an overview of the situation, this conference sets focus on studies documenting: the epidemiologic situation of cancer patients and survivors sustaining a professional activity; the socio-economic burden of the disease on work sector; qualitative aspects of impacts of the disease on working patients – or from any research field that helps to understand the situation of cancer, work and employment in Europe.

While the support to workers with or after cancer is being strengthened by public policies to prevent professional exclusion and stigmatization, what legal innovations should be used to support health-promoting work environments?

In France, the legislation provides for suspension of work contracts¹ and qualifies the work ability of patients-workers as a purely medical model defined as – incapacity, invalidity or unfitness. The obligation to employ workers with a disability completes this framework, and the incentive to apply for recognition as a worker with that disability after cancer is met with a mixed reception by the people concerned.

In Germany, the Netherlands, Italy, Canada and Australia, other legal provisions, whether by law or agreement, link return to work or job retention to work organization methods. The Canadian model resulted from the law on reasonable accommodation², the German model with the negotiated protocol of “management of integration in the establishment”³, and the Dutch model with a mandatory re-integration into a work plan guided by an occupational physician, and the Australian model supported by the Fair Work Act of 2009 and the “right to request flexible working arrangements”4 are all frames of reference that bear a broader conception of work, health and working conditions that are favorable work that supports health.

In countries with missing or less developed policy framework for employment (re)integration after cancer, actors have different challenges compared to the countries mentioned above – e.g. employers turn more to ad-hoc measures when dealing with the organisational issues derived from procedures adopted for sickness absence, return to work and work retention of workers diagnosed with cancer⁵; and the dynamic between compensation (providing financial benefits for sickness) and activation (encouraging work reintegration), which is regulated through legislation, is another key factor influencing how work with and after cancer are understood and dealt with by stakeholders^6,7.

Data on inclusion into employment, sustainable return to work and staying at work with or after cancer cannot be understood without relating them to the regulatory framework that shapes the systems and their use by the people and companies concerned. However, these frameworks (partially) exclude (new) groups such as self-employees and flexworkers; cross-country comparisons can show how to improve our occupational health and social insurance legislation. Therefore, the topic of this conference will welcome framework comparisons and studies to help understand their positive and unexpected impacts.

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[1] Célérié, S., 2008, « Cancer et activités professionnelles des malades : les enseignements de trente ans de littérature internationale sur le thème », Sociologie de la santé, n° 28
[2] « Guide d’accompagnement – traitement d’une demande d’accommodement », commission des droits de la personne et des droits de la jeunesse du Quebec, mai 2018
[3] « Les pratiques des acteurs d’entreprise face à la longue maladie et au handicap en Allemagne », Adelheid Hege, Christian Dufour, La Revue de l’Ires, 2010/4 n°67, pages 59 to 93
[4] https://www.fairwork.gov.au/tools-and-resources/best-practice-guides/flexible-working-arrangements
[5] de Rijk, A., Amir, Z., Cohen, M., et al. (2020). The challenge of return to work in workers with cancer: Employer priorities despite variation in social policies related to work and health. Journal of Cancer Survivorship: Research and Practice, 14(2), 188–199
[6] Anema, J. R., Schellart, A. J. M., Cassidy, J. D., et al. (2009). Can Cross Country Differences in Return-to-Work After Chronic Occupational Back Pain be Explained? An Exploratory Analysis on Disability Policies in a Six Country Cohort Study. Journal of Occupational Rehabilitation, 19(4), 419–426
[7] Lindsay, C., Greve, B., Cabras, I., Ellison, N., & Kellett, S. (2015). New Perspectives on Health, Disability, Welfare and the Labour Market (Vol. 49). John Wiley & Sons, Ltd

Knowledge of the short and long-term consequences of the disease’s effects on work conditions of individuals, such as fatigue, depression, anxiety, pain, and physical or cognitive after-effects – throughout their lives and regarding different cancer locations or restrictive care services – is available, but the identification of reliable interventional strategies and translation into professional guidelines is still in its infancy⁸.

Similarly, the existing literature on effective support regarding maintenance of work or return and access to work conditions – during and after treatment – is limited and therefore evidence-based interventions need to be developed. Their success largely depending on social synergies⁹ between healthcare professionals, companies and caregivers, this conference welcomes participative sciences and studies documenting socio-ecological model interventions and workplaces or communication work conditions. In this respect, this conference sets focus on assessing, improving and questioning the scalability of innovative interventions. It also welcomes studies supporting cancer survivors’s job retention and empowerment in social context and their environment – whether one is entering the job market, returning to work or attempting to continue work for the long-term after cancer.

Therefore, the topic of developing professional guidelines and interventions to ensure the quality of life at work and allowing people affected by cancer or cancer survivors, when desired, to continue developing their professional careers and ensure their job retention is at the core of this conference.

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[8] Silvaggi F, Leonardi M, Guastafierro E, Quintas R, Toppo C, Foucaud J, Lamore K, Rothe U, Scaratti C. Chronic Diseases & Employment: An Overview of Existing Training Tools for Employers. Int J Environ Res Public Health. 2019 Feb 28;16(5):718. doi: 10.3390/ijerph16050718. PMID: 30823368; PMCID: PMC6427204
[9] Silvaggi Fabiola, Leonardi Matilde, Raggi Alberto, Eigenmann Michela, Mariniello Arianna, Silvani Antonio, Lamperti Elena, Schiavolin Silvia Employment and Work Ability of Persons With Brain Tumors: A Systematic Review, Frontiers in Human Neuroscience , vol.14,2020, 10.3389/fnhum.2020.571191

Social disparities in health, cancer incidence and impacts on peoples’ work and employment situations are to be studied in the context of specific and collective professional careers. Understanding the implications of social and health disparities in the conciliation of cancer, work and employment, and developing adapted interventions for hard-to-reach populations – remote from the health system or with a low social gradient – are health equity imperatives. This conference set focuses on highlighting these issues by documenting specific difficulties encountered after and during cancer in the face of gender inequalities, status differences – e.g., self-employee or activity field – and social and territorial health access inequalities.

More vulnerable situations in face of the disease – e.g., older cancer patients, cancer patients with comorbidities or palliative care, rare cancer patients or (partly) disabled cancer patients – are also to be taken into consideration to better understand the various impacts of the disease on occupational trajectories.